Modification of the Psychosocial Assessment of Candidates for Transplantation (PACT) Improves Risk Classification and Prediction of Hospital Readmission of MCS Patients

Abstract

Purpose We previously demonstrated that the PACT falsely characterized some patients (pts) considered for MCS therapy as high risk. We developed and evaluated a new MCS-specific PACT; thus, the purpose of this study was to examine the sensitivity and specificity of this revised instrument to classify MCS pts. Methods and Materials PACT domains were re-written to reflect psychosocial criteria influencing social success defined as a reliable support system, discharge on schedule, and no social re-admissions. Areas of concern for HT candidates were eliminated and social support was emphasized. A social worker, blinded to outcomes, re-scored previously studied pts with the revised instrument. mPACT and PACT scores were then compared. Team members were surveyed: Was this pt a social success? Answers were assigned a value [no=0, yes=1] to determine a social success score. Success was considered a mean score >.5. Results 48 pts (72% men, 44% AA, 50.4 yrs) supported on MCS for 274 days were evaluated. The sensitivity of a score of 17 to identify a social success was .97 and the specificity was .56. The PPV was .97 and NPV was .56, compared to .86 and .44 respectively, for the PACT. A reclassification table was developed to assess the difference in risk stratification of the mPACT compared to the PACT. Net reclassification showed 19% improvement in risk stratification by the mPACT. Five of the 9 patients falsely categorized as high risk by the original PACT score were appropriately re-categorized as low risk with the mPACT. Patients with an mPACT score Conclusions By eliminating risk factors that do not have the same bearing on MCS outcome as HT and emphasizing areas of social support, we appropriately re-classified patients as acceptable risk who had been incorrectly considered high risk by the PACT. The mPACT score showed improved performance and warrants prospective validation.